Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Chronic hypertension medical therapy blood pressure goals of treatment
Introduction
The 24-hour ambulatory systolic pressure may better mortality than the daytime systolic blood pressure.
Regarding the accuracy of office oscillometric and home blood pressure monitoring compared with ambulatory blood pressure monitoring, a meta-analysis by the Rational Clinical Examination found[1]:
- Office pressures (presumably attended by medical personnel) has sensitivity and specificity of 51% and 88%
- Home monitoring has sensitivity and specificity of 75% and 76%
Elevated high-sensitivity cardiac troponin T (hscTnT) and N-terminal pro-B-type natriuretic peptide (NTproBNP) levels may help guide treatment.
The decision to treat may be affected by projected longevity of a patient[2]:
- “for patients 60 years and older with hypertension, intensive BP treatment may be appropriate for some adults with a life expectancy of greater than 3 years
- “but may not be suitable for those with less than 1 year.”
Clinical practice guidelines
Recommendations for treatment goals from recent clinical practice guidelines are tabulated below. However, treated based on underlying risk rather than a blood pressure target may be more effective. The logic supporting a target of 130/80 mm Hg has been disputed and the Cochrane Collaboration found insufficient evidence to determine a treatment goal for adults or adults over 65 years of age.
If the goal is 130/80, proper measurement includes (distilled from Table 8 of the ACC/AHA guidelines, executive summary):
- having the patient sit quietly for 5 minutes before a reading is taken
- supporting the limb used to measure BP
- ensuring the BP cuff is at heart level
- using the correct cuff size
- for auscultatory readings, deflating the cuff slowly
- the timing of BP measurements in relation to ingestion of the patient’s medication should be standardized
- a single reading is inadequate for clinical decision-making. An average of 2 to 3 BP measurements obtained on 2 to 3 separate occasions will minimize random error and provide a more accurate basis for estimation of BP.
If the above measurement methods are not use, a preliminary study from Kaiser Northern California suggests a target of 140 mm Hg.
| Clinic (routine)
AHA, 2017 |
|---|
- ↑ Viera AJ, Yano Y, Lin FC, Simel DL, Yun J, Dave G; et al. (2021). “Does This Adult Patient Have Hypertension?: The Rational Clinical Examination Systematic Review”. JAMA. 326 (4): 339–347. doi:10.1001/jama.2021.4533. PMID 34313682 Check
|pmid=value (help). - ↑ Chen T, Shao F, Chen K, Wang Y, Wu Z, Wang Y; et al. (2022). “Time to Clinical Benefit of Intensive Blood Pressure Lowering in Patients 60 Years and Older With Hypertension: A Secondary Analysis of Randomized Clinical Trials”. JAMA Intern Med. doi:10.1001/jamainternmed.2022.1657. PMID 35532917 Check
|pmid=value (help).
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Robert G. Badgett, M.D.[2]